Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study

International trends in male youth suicide and suicidal behaviour

OBJECTIVE

Suicide and suicidal behaviour strongly contribute to overall male youth mortality. An understanding of worldwide data contextualises suicide and suicidal behaviour in young men within any given country.

METHOD

Members and colleagues of the World Federation of Societies of Biological Psychiatry's Task Force on Men's Mental Health review the relevant data from several regions of the world. The review identifies notable findings across regions of relevance to researchers, policymakers, and clinicians.

RESULTS

Male suicide and suicidal behaviour in adolescence and emerging adulthood within North America, Latin America and the Caribbean, Europe, the Mediterranean and the Middle East, Continental Africa, South Asia, East Asia, China, and Oceania share similarities as well as significant points of divergence.

CONCLUSIONS

International data provide an opportunity to obtain a superior understanding of suicide and suicidal behaviour amongst young men.

Current Psychotic-Like Experiences Among Chinese College Students: Prevalence, Correlates, and Its Relationship with Suicidal Ideation

Background

Current psychotic-like experiences (PLEs) are prevalent among adolescents. However, epidemiological data on the prevalence rate of current PLEs among college students and its clinical correlates are scarce and limited. To address this study gap, this study aimed to investigate the prevalence and correlates of current PLEs among Chinese college students.

Methods

A cross-sectional study was designed with a sample of 18,578 college students in China. Each participant completed a survey on social-demographic characteristics variables, PLEs, sleep disturbance, depression, anxiety, and suicidal ideation. Logistic regression analyses were conducted to explore the influential factors for PLEs among all participants and suicidal ideation among those with PLEs.

Results

Among Chinese college students, 40.3% of the participants reported having at least one PLE in the past month, while 7.5% had frequent PLEs. Males, age, residence location in town, left-behind experiences, poor family economic status, chronic physical illness, family history of mental disorder, BMI ≥ 28 [obesity], sleep disturbance, depression, anxiety, and suicidal ideation were independent correlates for frequent PLEs. Furthermore, the prevalence of suicidal ideation among participants with frequent PLEs was 32.1%. Lower grades, sleep disturbance, depression, and anxiety were independent predictors of suicidal ideation among college students who experience PLEs frequently.

Conclusion

Current PLEs are widespread among Chinese college students. Suicidal ideation is largely prevalent among individuals who suffer frequent PLEs, suggesting that special measures and attention should be provided to these students based on relevant factors to prevent their suicidal ideation and behavior.

Suicide, suicide attempts and self-harm in Moroccan prisons

PURPOSE

High rates of suicide and self-harm are reported in prisons in Western countries, while fewer studies exist from a non-Western context. This study aims to identify rates of suicide, non-fatal suicide attempts and self-harm in Moroccan prisons and to better understand the context, methods, tools, predictors and profile of persons engaged in the acts.

DESIGN/METHODOLOGY/APPROACH

The authors report findings from a mixed-methods study carried out before an intervention project. The study consists of a systematic literature review, an analysis of suicide case files, a quantitative survey on suicide attempts and self-harm, as well as interviews and focus group discussions. The authors calculate suicide, suicide attempt and self-harm rates and present descriptive data on the incidents. The authors use regression models to explore the association between the number of incidents per individual and selected predictors, adjusting for clustering by institution.

FINDINGS

Over a four-year period, 29 detained persons in Morocco died by suicide (average annual suicide rate 8.7 per 100,000). Most were men under the age of 30. Hanging accounted for all but one case. In one year, 230 suicide attempts were reported. Over a three-months period, 110 self-harm cases were reported from 18 institutions, cutting being the most common method. Self-harm was significantly more prevalent among persons with a life sentence or repeated incarcerations.

RESEARCH LIMITATIONS/IMPLICATIONS

To make the study manageable as part of an intervention project, the authors collected data on suicides and suicide attempts from all prisons, while data on self-harm were collected from fewer prisons and over a shorter time period. The authors did not collect comparable information from detained persons who did not die by suicide, attempt suicide or self-harm. This prevented comparative analyses. Further, it is possible that self-harm cases were not reported if they did not result in serious physical injury. Data were collected by prison staff; thus, the voice of incarcerated persons is absent.

PRACTICAL IMPLICATIONS

This study provided a solid basis for designing an intervention project including the development of a national prison policy and guidelines on suicides, suicide attempts and self-harm and a country-wide training program for prison staff. It also led to a better surveillance system, allowing for trend analysis and better-informed policymaking. The qualitative results helped create an understanding of how staff may trivialize self-harm. This was integrated into the training package for staff, resulting in the creation of prison staff trainers who became the strongest advocates against the notion that self-harm was best ignored.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first published data on suicide and self-harm in Moroccan prisons. It underscores the necessity for the intervention project and gives valuable insights into suicide and self-harm in a non-Western prison context. Further research is needed to assess whether the findings are typical of the region.

Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis

BACKGROUND

Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis.

METHODS

To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2).

RESULTS

In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively.

CONCLUSION

Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.

Validation of the Center for Epidemiologic Studies Depression Scale (CES-D) in a Moroccan sample with substance use disorder

BACKGROUND

Transcultural validation studies of depression scales are rare in Morocco. The Center for Epidemiologic Studies Depression Scale (CES-D) is commonly one of the most common and frequently used screening instruments for depressive symptoms, but the scale has not, up to date, been validated in dialect of Arabic in Moroccan contexts. Given the importance of assessing and preventing depressive symptoms in our Moroccan context, this study aims to validate the CES-D, translated, and adapted to the dialect of Arabic and Moroccan culture, in a sample with substance use disorder.

METHODS

The data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 140). Then, this structure was confirmed in the validation sample (N = 205) using confirmatory factor analysis (CFA).

RESULTS

Exploratory factor analysis extracted three factors different from the four factors in the original version. Confirmatory factor analysis confirmed the structure of three factors. The fit indices level showed acceptable to good performance of the measurement model. The instrument showed sufficient reliability and convergent validity, as demonstrated by acceptable values of composite reliability (CR = 0.89-0.93) and average variance extracted (AVE = 0.64-0.66), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio (HTMT) of correlations values was less than 0.85, indicating acceptable discriminant validity.

CONCLUSIONS

Overall reliability and both convergent and discriminant validity tests indicated that the Moroccan dialectal Arabic version of the CES-D had a good performance and may serve as a valid tool for measuring the severity of depression in people with substance use disorder.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]

OBJECTIVES

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population.

METHOD

Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded.

RESULTS

This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide.

CONCLUSION

Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

[Tentatives de suicide au Maroc: une revue systématique]

BACKGROUND

Suicide is a widespread phenomenon that affects persons of all ages, and it has become a major public health problem in Morocco.

OBJECTIVES

This study aims to describe the epidemiological profile of suicide attempters in Morocco, as well as the identification of associated factors.

METHODS

The present work is a systematic review that was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analysis (2009)", including articles dealing with suicide attempts in Morocco that meet the usual inclusion criteria. The PubMed, ScienceDirect and Scopus databases were searched; articles had to be written in English or French. Additional studies were manually identified through via Google Scholar. Quality assessment of the included studies was carried out according to the NIH Assessment Tool. The review protocol was registered in PROSPERO (CRD42020165493).

RESULTS

Twenty studies were selected. Adults and adolescents are the age groups most affected by suicide. That said, the phenomenon mainly concerns children over 10 years of age. In some studies, more than 90% of the cases involve females, and they are more numerous in urban than in rural settings, and single individuals are more affected than married people. As for children and adolescents, most of them had divorced parents, and more than 50% of suicidal persons of all ages had a low socio-economic level. Although females are more likely than males to commit suicide, males are more exposed to death due to the violent means used.

CONCLUSIONS

Because of the alarming rate of suicide in our country, nationwide prevention strategies are called for.

Factors associated with suicidality among school attending adolescents in morocco

Suicide amongst adolescents is a growing epidemic accounting for 6% of all adolescent deaths. Even though 79% of adolescent suicides occur in low- and middle-income countries, where suicide is the second leading cause of death, research is relatively lacking. As such, we aim to gain a greater understanding of suicide in said countries by assessing ideation and planning and associated factors in Morocco. Global Schools Health Survey data was analyzed. Approximately 14.4 and 12.9% reported ideation and planning respectively during the prior year in 2016, indicating a decrease from the reported rates of ideation of 16.0 and 17.0% and planning of 14.6 and 15.0% in 2006 and 2010 surveys respectively. Increased ideation was found to be positively associated with identifying as female and increasing age, whereas planning was positively associated with a lower educational level and living in a rural area. Both were positively associated with increased hunger frequency. Several factors increased the likelihood of ideation: bullying, feeling lonely, current cigarettes smoking, and current marijuana use. Studying factors associated with suicide is challenging, alternatively, factors affecting ideation and planning can be assessed. Sociocultural differences may impact trends in a specific region, though countries in said region may have comparable trends. The study adds to the limited data available in the region. Reverse causality and under-reporting could be the main limitations of this study. Interventions taking into account those results should be tested to decrease such a prevalence.

Correlates of Suicide Attempts in Filipino Youths: An Analysis Based on the 2015 Global School-Based Student Health Survey

There is a lower incidence of suicide in the Philippines compared to other developed/developing countries, but the trend has been increasing. This study aims to identify the correlates of suicide attempts in Filipino youth using the World Health Organization's 2015 Global School-Based Health Survey. All schools in the Philippines with grades 7-10 were included. A stratified sampling design was used, and participants were randomly sampled. Of the 8,761 students who participated in the survey, 16.2% have attempted suicide at least once in the past 12 months. The factors that increased the risk of suicide attempts include female gender, being physically attacked, getting bullied, feeling lonely, poor sleep, having few close friends, smoking, alcohol use, less physical activity, use of amphetamine/methamphetamine, and less parental supervision. The use of methamphetamine/amphetamine is the single best risk factor of suicide attempts among Filipino youth with OR= 4.6; 95% CI [3.8, 5.6].

Suicidal tendencies and its association with psychoactive use predictors among university students in Uganda: a cross-sectional study

BACKGROUND

Globally, suicide is one of the leading causes of death, and approximately 80% of all suicides occur in lowand middle-income countries. Younger people in Africa are at a higher risk of suicide than others.

OBJECTIVE

To describe the prevalence and factors associated with suicidal tendencies among undergraduate university students using alcohol and other psychoactive substances.

METHODS

Convenient sampling was used to identify 400 students who participated in the study. Socio-demographic and Mini-International Neuropsychiatric Interview tools were used to obtain information. Data were analyzed using SAS 9.4 and presented in descriptive and inferential statistics.

RESULTS

Among the respondents, 80% were male, and 85% were using marijuana. 6.3% had suicidal tendencies. Respondents from the northern region had more suicidal tendencies than other regions, and unemployed students had more suicidal tendencies than those employed. After multivariate analysis, being abusive and dependent on other psychoactive substances was associated with suicidality. And having dependence on both alcohol and other psychoactive substances was associated with suicidality.

CONCLUSION

Suicidality screening and psychosocial support should be provided to this vulnerable population. Efforts There is a need to strengthen, implement more effective preventive strategies to reduce the use of alcohol and other psychoactive substances.

Suicidal Behavior in the Mediterranean Countries

Introduction:

Suicidal behavior is a serious public health problem worldwide and shows large intersocietal variation. This study aimed at comparatively investigating the aspects of suicidal behavior in 22 countries surrounding the Mediterranean Sea.

Methods:

The study was conducted with official data retrieved from several sources. The suicidal mortality data were collected from World Health Organization’s data repository. Descriptive statistics, group comparison, correlational and regression statistical analyses were used to summarize the data.

Results:

The average age standardized suicide rates in the Mediterranean countries are lower than the world average. Except in Morocco, more men kill themselves than women. Suicide rates are lower in Mediterranean Muslim than in Mediterranean Christian countries. Slovenia, France and Croatia have the highest suicide mortality rates. Greatest percentages of suicidal ideation are seen in Croatia, Turkey and Slovenia and the greatest percentages of suicidal attempts are seen in Palestine, Cyprus, Greece and Slovenia. According to the results of the multiple regression analyses, the coefficient of human inequality index was associated with lower both-sex and male suicide rates. Greater percentages of people saying religion is unimportant in daily life in a country were found to be related to higher female suicide rates.

Conclusion:

The findings from the study have shown that the prevalence of suicidal deaths, thoughts and attempts vary between the Mediterranean countries. Lower suicide rates are observed in the Muslim Mediterranean nations than in the Judeo-Christian ones. However, the rates of suicide mortality in non-Arab Muslim nations being comparable to the rates in non-Muslim countries confirm the concerns over mis/underreporting of suicidal behavior in Arab Muslim countries due to religio-cultural stigma attached to suicide. The average suicidal mortality rates are lower in Mediterranean countries than the world average. Generally, more men than women kill themselves. Results from the multivariate analysis revealed that as the level of human inequality increases the rates for both-sex and male suicidal mortality decreases. Religion seem to be protective against female suicides. The study has also shown that more research is needed about suicidal behavior in the Mediterranean countries.

Association between the use of Cannabis and elevated suicide risk in high school adolescents from Santa Marta, Colombia

Introducción.

La prevalencia del consumo de Cannabis sigue en aumento en el mundo, especialmente, entre adolescentes. Dicho consumo se sobrepone al de cigarrillos y otras sustancias lícitas e ilícitas, y se ha asociado con síntomas depresivos e incremento del riesgo suicida. En el contexto colombiano poco se conoce sobre la relación entre el consumo de Cannabis y el riesgo de suicidio.

Objetivo.

Evaluar la asociación entre el consumo de Cannabis y el riesgo suicida en adolescentes escolarizados de Santa Marta, Colombia.

Materiales y métodos.

Se hizo un estudio transversal con una muestra probabilística de estudiantes de media vocacional entre los 13 y los 17 años de edad en colegios oficiales y privados. Se indagó sobre el consumo de Cannabis alguna vez en la vida y se cuantificó el riesgo suicida con la Center for Epidemiologic Studies on Depression Scale. Las puntuaciones superiores a ocho se categorizaron como riesgo suicida elevado. Se estimó la razón de oportunidad (OR) cruda y la ajustada.

Resultados.

Participaron 1.462 estudiantes. La media para la edad fue de 14,4 años (desviación estándar, DE=0,8) y el 60,3 % correspondía a mujeres. La prevalencia del consumo de Cannabis alguna vez en la vida fue del 11,6 % (IC_95% 10,0-13,2) y el 13,3 % (IC_95% 11,6-15,0) de los estudiantes presentó riesgo suicida elevado. El consumo de Cannabis se asoció con dicho riesgo ajustado por otras variables (OR=1,88; IC_95% 1,23-2,88).

Conclusiones.

El consumo de Cannabis se asoció con el riesgo suicida elevado en adolescentes escolarizados de Santa Marta, Colombia. Es necesario analizar otras variables que pueden mediar esta asociación.

Integrative Review of Related Factors and Defining Characteristics of Lack of Family Integrity

PURPOSE

To identify the related factors that compromise family integrity and the defining characteristics of poor family integrity.

METHODS

Integrative review in databases: Pubmed, Scopus, Cinahl, PsycInfo, and Web of Science. The inclusion and exclusion criteria led to the selection of 12 articles.

FINDINGS

Family conflicts, lack of communication, and detachment from family as risk factors that have a negative impact on family integrity. A decrease in the physical and psychological quality of life as defining characteristics of poor family integrity.

CONCLUSIONS

Lack of family integrity has a significant impact on the physical, mental, and social health of its members.

IMPLICATIONS FOR NURSING PRACTICE

Findings will allow nurses to implement interventions for the maintenance or improvement of family integrity.

The association between psychological strain and suicidal behaviors among college students: A mental health survey in Jilin Province, Northeast China

BACKGROUND

Suicide is a major global mental health problem among college students. The aim of the current study was to explore the association between the psychological strains of the strain theory of suicide and suicidal behaviors among college students.

METHODS

Participants comprised 1912 college students (16-28 years old, 47.2% female) from three universities in Jilin Province, China, who completed the self-report assessments of psychological strains (40 items Psychological Strains Scale) and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised). The demographic characteristics included four variables: health status, psychological status, academic status and economic status.

RESULTS

Approximately 15.0% (286/1912) of participants were classified as having suicide risk, based on the cut-off scores of the SBQ-R. The prevalence of suicidal behaviors among males and females was 11.9% (120/1009) and 18.4% (166/903), respectively. Value strain (OR = 1.075, 95%CI: 1.057-1.094), aspiration strain (OR = 1.082, 95%CI: 1.064-1.101), deprivation strain (OR = 1.073, 95%CI: 1.052-1.093), and coping strain (OR = 1.095, 95%CI: 1.075-1.116) were risk factors for suicidality in college students. Coping strain (OR = 1.050, 95%CI: 1.023-1.077) was still positively associated with suicide risk in multivariate logistic regression. Logistic regression analysis indicated that coping strain had the highest correlation with suicidal behaviors.

LIMITATIONS

The directionality of the relationships cannot be deduced because this study is cross-sectional.

CONCLUSION

This study confirms a strong association between psychological strains and suicidal behaviors in college students. Some measures can be taken to reduce psychological strains to mitigate suicide risk among college students. More studies investigating coping strain among college students are warranted.

Factors Associated With Suicidal Attempt Among School-Going Adolescents in Malaysia

Various factors contribute to suicidal attempt. This study aims to determine the relationship between suicidal attempt and its associated factors among school-going adolescents in Malaysia. Data from the National Health and Morbidity 2017 survey were analyzed. This survey was implemented as a nationwide school-based survey targeting adolescents 13 to 17 years old. Descriptive and multiple logistic regression analysis was done using SPSS version 20. A total of 27 399 adolescents participated in this survey. The prevalence of suicidal attempt was 6.9% (95% confidence interval = 6.2-7.7). Multivariate analysis found that the odds of suicidal attempt among adolescent with depression is 4.3 (adjusted odds ratio = 4.3; 95% confidence interval = 3.9-4.8). Other significant factors are young adolescent, non-Malay ethnicities especially Indian, adolescent with parents living apart, and those without peer support and parental connectedness. A holistic approach for the planning of preventative strategies and public health policies should be made according to these risk factors.

Suicidality among Lebanese adolescents: Prevalence, predictors and service utilization

Suicide and self-harm in young people is a global public health issue, although epidemiological evidence remains scant in many parts of the world. The aims of the present study are to describe the prevalence, comorbidity patterns, and the clinical and demographic correlates of suicidality among a representative sample of adolescents from Beirut, Lebanon. We recruited 510 adolescents aged 11-17 and one of their parents/legal guardians using a multistage random cluster design. The validated Arabic version of the Development and Well-Being Assessment (DAWBA) was administered independently to the parent/legal guardian, and adolescents, who also self-completed the Strengths and Difficulties Questionnaire (SDQ), and the Peer-Relations Questionnaire (PRQ). The parent/legal guardian also completed the SDQ and provided demographic and clinical information. A total of 22 adolescents (4.3%) have experienced suicidal ideation or attempt. Correlates of suicidality were female gender, alcohol use in the past 4 weeks, lifetime exposure to a stressful life event, suffering from a major depressive disorder and having bipolar disorder within the last 4 weeks. Only 1 suicidal participant reported ever seeking professional mental health help. Our findings highlight an alarming treatment gap in Lebanese adolescents experiencing suicidality. Future studies should aim at investigating barriers to care and at developing community-based interventions to improve access to care.

Characteristics of patients attending the child and adolescent psychiatric outpatient clinic in Erbil city

BACKGROUND

The Erbil psychiatric hospital is the major governmental psychiatric facility in the governorate of Erbil, the capital of the Kurdistan region in Iraq, providing services for the diagnosis, treatment and follow-up of patients from the city and its surrounding areas. The child and adolescent outpatient clinic in the hospital is for patients younger than 18 years. The objectives of this study were to explore the sociodemographic, pregnancy and birth characteristics, as well as the clinical profiles, of patients who presented to the child and adolescent psychiatric outpatient clinic to statistically estimate the frequency of various psychiatric disorders among the attendees and to test hypotheses of the association of these psychiatric disorders with sociodemographic and birth and pregnancy characteristics as reported by many previous studies but with inconsistent results.

METHODS

A descriptive consecutive cross-sectional study was conducted from October 2017 to February 2018 in the Child and Adolescent Psychiatric Outpatient Clinic in Erbil province of Iraq's Kurdistan region. The diagnostic criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) were implemented. Chi-square tests were used to test the hypothesized associations.

RESULTS

Of a total of 207 patients, 142 were males and 65 were females, and most lived in low socioeconomic status. Most of the patients' fathers were school educated, and most mothers were illiterate. Consanguinity was found in 41% of the parents, 26.6% of the patients were born by caesarean section(C/S), 62.8% were nurtured exclusively by breastfeeding in their first six months after birth, 42.5% of them visited faith healers before consulting a psychiatrist, 43% had neurodevelopmental disorders, 26.6% had intellectual disabilities with behavioral and emotional comorbidities and 30.4% had other mental/behavioral disorders.

CONCLUSION

This study revealed that the child and adolescent psychiatric disorders in Erbil city are versatile and that many factors are significantly associated with them. Cultural concepts are still influential in the region in a way that can interfere with children's well-being, a situation that calls for more concern and attention.

Association Of Cigarette Smoking With Anxiety, Depression, And Suicidal Ideation Among Brazilian Adolescents

BACKGROUND

Several studies worldwide have pointed to depression and anxiety symptoms as being related to adolescent smoking. The aim of this study was to investigate, the potential link of cigarette smoking with depression, anxiety, and suicidal ideation and the influence of gender on these relationships in Brazilian adolescents.

METHODS

Associations of smoking with Children Depressive Inventory version 2 (CDI2) scores, Hamilton Anxiety Scale (HAM-A) scores, and poor school performance (i.e., grade retention) were examined in 988 Brazilian students (age range, 11-17 years) enrolled in 82 public and private schools. Logistic regression modeling was employed and the resultant odds ratios (ORs) are reported with 95% CIs.

RESULTS

Of 988 participants, 240 (24.3%) were smokers. Mean (±standard error) HAM-A scores were higher for smokers (21.1 ± 9.7) than nonsmokers (15.4 ± 8.6; p < 0.0001). Relative to nonsmokers, smokers had higher total CDI2 scores (p = 0.033), and higher scores for the CDI2 domains of Emotional Problems (p = 0.023), Negative Self-esteem (p < 0.001), and Functional Problems (p = 0.046). Suicidal ideation was common among smokers with depressive symptoms (54.2%). Smoking was associated with being held back three grades (p < 0.001). Female smokers were more likely to report suicidal ideation than male smokers (p = 0.020). Logistic regression modeling revealed significant associations of suicidal ideation with being female (OR, 1.81; 95% CI, 1.38-2.37), being a female smoker (OR, 2.05; 95% CI, 1.51-2.80), and having a HAM-A score > 16 (OR, 2.18; 95% CI, 1.66-2.86).

CONCLUSION

Smoking was found to be associated with anxiety symptoms, depressive symptoms, and poor school performance in Brazilian adolescents; and female smokers reported more suicidal ideation than male smokers.

Predictors of suicidal ideation and depressive symptoms among adolescents in Chiapas, Mexico

The aim of this study was to assess the presence of suicidal ideation and depressive symptoms among adolescents in Chiapas, Mexico based on predictor variables. A cross-sectional study adopting an ex post facto design was conducted with a non-probability sample of 4,759 students of both sexes with an average age of 18.4 years and using the following tools: the Center for Epidemiologic Studies Depression Scale, Roberts' Suicidal Ideation Scale, the Impulsiveness Scale (IS), and the Rosenberg Self-Esteem Scale. The mean score obtained by the suicidal ideation scale was 0.2, which is lower than that reported by other studies, while the mean score for depressive symptoms was similar to those in the literature. The prevalence of suicidal ideation was 7.8%, which is lower than reported in national and international studies. Multivariable logistic regression showed that impulsiveness (OR = 1.907) and depressive symptoms (OR = 9.006) lead to a twofold and ninefold increase in the likelihood of suicidal ideation, respectively. The findings also showed a strong association between suicidal ideation and depressive symptoms, showing that the latter is a predictor of suicidal ideation among adolescents.

Adolescents, parents and teachers' perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study

Background

Substance use in adolescents is a global public health concern that continues to draw attention from academics, policy experts, and government officials. In Morocco, few studies have investigated the influencing factors of substance use in adolescents. Here, we aimed to fill this gap and to better understand factors that protect or influence substance use in adolescents.

Methods

We conducted a qualitative study using focus group discussions. The semi-structured interview guides were based on the socio-ecological model as a theoretical framework to explore perceptions of students, parents, and teachers regarding substance use risks and protective factors in adolescents. Data from each group were audio-recorded, transcribed, and analyzed using thematic analysis.

Results

From May to July 2016, 17 focus group discussions were conducted at two middle schools in Taza city, Morocco, which included 8 groups of 7 adolescents (28 boys and 28 girls) aged 14 to 16 years, 5 groups of parents (5 females and 21 males), and 4 groups of teachers (13 males and 5 females). Thematic analysis resulted in six common themes that represented the most salient perceived risk and protective factors regarding substance use among adolescents: perceived benefits of substance use, awareness and beliefs, family influence, peer influence, easy accessibility of substances, and social norms.

Conclusions

Our results demonstrate that multilevel prevention programs in adolescents should address influencing factors from the individual to the societal level, including social norms and the government’s policy toward substance use. Health education programs included as part of the school curriculum can contribute to promoting awareness and reducing risky behaviors of Moroccan adolescents.

Prevalence and Correlates of Suicidal Behaviors among College Students in Northeastern China: a Cross-Sectional Study

The present study aimed to investigate the prevalence and correlates of suicidal behaviors among college students in Jilin Province, China. A cross-sectional survey was conducted in 2016, using a self-reported questionnaire. Convenience sampling method was used to select college students as participants. The analysis was based on a sample of 730 college students. We use multivariate logistic model to determine the risk factors of suicidal behaviors.The prevalence of suicidal ideation, suicidal plan, suicidal attempts were respectively 13.2%, 3.3% and 3.4%. After controlling for the potential confounding factors, history of family psychiatric illness, depression and quality of life were significantly associated with suicidal ideation. Besides, suicidal plan was predicted significantly by not living together with university roommates and depression. In terms of suicidal attempts, not living together with university roommates and history of family psychiatric illness were its risk factors. Comprehensive interventions regarding aims at risk factors may be critical as effective strategies to protect college students from suicide.

Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review

Background

Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs.

Methods

We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist.

Results

Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables.

Conclusions

Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5425-6) contains supplementary material, which is available to authorized users.

The interaction of gender and cannabis in early phase psychosis

Cannabis is the third most common recreational drug used world-wide after tobacco and alcohol. Globally, cannabis legalization is becoming more common. In light of its known link to psychosis development, it is imperative that we are well-informed regarding the impact of cannabis on the course of psychosis, in both males and females. However, the majority of the work to date on the role of cannabis in psychosis outcomes has not had a gender focus, important when considering patient specific treatments. This review examines what is currently known, from gender focused studies, about the interaction of gender, cannabis use and psychotic disorders.

Suicidal ideation and planning among Palestinian middle school students living in Gaza Strip, West Bank, and United Nations Relief and Works Agency (UNRWA) camps

The goal of this study was to identify the prevalence and correlates of suicidal thinking among Palestinian middle school students by using complex samples analysis to explore data about suicidal ideation and suicidal planning in the past year from 14,303 students in grades 7, 8, and 9 (roughly ages 13–15 years) who participated in the Global School-based Student Health Survey (GSHS) in 2010 in the Occupied Palestinian Territory (OPT) and United Nations Relief and Works Agency (UNRWA) refugee camps. We also analyzed data from the seven other GSHS-participating countries from the Eastern Mediterranean region: Iraq, Jordan, Kuwait, Lebanon, Morocco, Tunisia, and the United Arab Emirates. The overall prevalence of suicidal ideation and/or planning was 25.6%. Males were more likely than females to report suicidal thinking. The health behaviors and exposures most strongly associated with suicidal thinking were marijuana use, having no close friends, tobacco use, loneliness, worry-induced insomnia, food insecurity, and being the victim of a bully. Being involved in physical fights and attacks, skipping school, and perceptions of limited parental support were also associated with suicidal thinking. The prevalence of suicidal thinking among Palestinian adolescents was higher than the rates in the other GSHS-participating countries, pointing toward a need for improved access to adolescent mental health services.